Pub Date : 2021-11-18DOI: 10.1093/oso/9780190077013.003.0014
Leo Mercer, Valerie Canary, Michelle E. Maxson
This chapter reviews issues related to mortality in the intensive care setting. Relevant literature is summarized and emphasizes the common need patients have for more frequent assessment, dependency on technology support, and psychosocial intervention. The authors stress the importance of interdisciplinary teams and the unique staffing and workforce challenges they encounter. Despite agreement on its importance, the authors maintain that end-of-life care is associated with a lack of consensus around its implementation at the bedside. The diversity within patient groups, diseases and conditions, and health care providers results in an environment in which the interplay of a growing number of variables influences the engagement of patients and families in discussions about end-of-life planning and care, futility, palliation, or withdrawal of support.
{"title":"Systemic Factors Impacting Mortality and End-of-Life Issues in Critical Care","authors":"Leo Mercer, Valerie Canary, Michelle E. Maxson","doi":"10.1093/oso/9780190077013.003.0014","DOIUrl":"https://doi.org/10.1093/oso/9780190077013.003.0014","url":null,"abstract":"This chapter reviews issues related to mortality in the intensive care setting. Relevant literature is summarized and emphasizes the common need patients have for more frequent assessment, dependency on technology support, and psychosocial intervention. The authors stress the importance of interdisciplinary teams and the unique staffing and workforce challenges they encounter. Despite agreement on its importance, the authors maintain that end-of-life care is associated with a lack of consensus around its implementation at the bedside. The diversity within patient groups, diseases and conditions, and health care providers results in an environment in which the interplay of a growing number of variables influences the engagement of patients and families in discussions about end-of-life planning and care, futility, palliation, or withdrawal of support.","PeriodicalId":445464,"journal":{"name":"Critical Care Psychology and Rehabilitation","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127428342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-18DOI: 10.1093/oso/9780190077013.003.0007
C. Hayhurst, Mina F. Nordness
This chapter reviews the psychologist’s role in pain management in critical care settings. Assessment and intervention strategies are discussed while also highlighting the importance of interdisciplinary collaboration. The authors describe how undertreated or unrecognized pain can lead to acute alterations in physiology and psychological stress that can worsen short- and long-term outcomes. Research is reviewed that emphasizes psychosocial factors that influence pain and suggests that a greater role is emerging in the critical care setting for psychologists. The chapter also explores the prevalence, causes, and consequences of pain in the intensive care unit, discussing not only possible pharmacologic treatment strategies but also opportunities for improved assessment and psychological treatment strategies. Areas of interest for future research are also addressed.
{"title":"The Psychologist’s Role in Pain Management in the Intensive Care Unit","authors":"C. Hayhurst, Mina F. Nordness","doi":"10.1093/oso/9780190077013.003.0007","DOIUrl":"https://doi.org/10.1093/oso/9780190077013.003.0007","url":null,"abstract":"This chapter reviews the psychologist’s role in pain management in critical care settings. Assessment and intervention strategies are discussed while also highlighting the importance of interdisciplinary collaboration. The authors describe how undertreated or unrecognized pain can lead to acute alterations in physiology and psychological stress that can worsen short- and long-term outcomes. Research is reviewed that emphasizes psychosocial factors that influence pain and suggests that a greater role is emerging in the critical care setting for psychologists. The chapter also explores the prevalence, causes, and consequences of pain in the intensive care unit, discussing not only possible pharmacologic treatment strategies but also opportunities for improved assessment and psychological treatment strategies. Areas of interest for future research are also addressed.","PeriodicalId":445464,"journal":{"name":"Critical Care Psychology and Rehabilitation","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124142116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-18DOI: 10.1093/oso/9780190077013.003.0011
S. Nayak, Jonathan Brigham, T. Gerstenblith, E. Prince
Psychotropic medications can be a powerful tool for enabling treatment of critically ill patients. However, a careful approach to psychopharmacology is necessary in the critical care setting. Special considerations include interactions with other medications and treatments, high levels of physiologic stress that alter metabolism, and the challenges of obtaining diagnostic clarity due to limitations in assessment and confounding factors during critical illness. This chapter outlines common consult questions posed by intensive care teams to psychiatry consultation teams, including management of agitation and sedation, poor participation in care, anxiety, continuation of outpatient medication regimens, and alternatives to oral medication.
{"title":"Psychopharmacology in the Critical Care Setting","authors":"S. Nayak, Jonathan Brigham, T. Gerstenblith, E. Prince","doi":"10.1093/oso/9780190077013.003.0011","DOIUrl":"https://doi.org/10.1093/oso/9780190077013.003.0011","url":null,"abstract":"Psychotropic medications can be a powerful tool for enabling treatment of critically ill patients. However, a careful approach to psychopharmacology is necessary in the critical care setting. Special considerations include interactions with other medications and treatments, high levels of physiologic stress that alter metabolism, and the challenges of obtaining diagnostic clarity due to limitations in assessment and confounding factors during critical illness. This chapter outlines common consult questions posed by intensive care teams to psychiatry consultation teams, including management of agitation and sedation, poor participation in care, anxiety, continuation of outpatient medication regimens, and alternatives to oral medication.","PeriodicalId":445464,"journal":{"name":"Critical Care Psychology and Rehabilitation","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114658284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-18DOI: 10.1093/oso/9780190077013.003.0002
E. Rubin
This chapter details the story of a critical illness survivor and highlights aspects of the patient’s experience during an intensive care unit admission. The former patient’s story is provided to add context and perspective while highlighting the psychological and rehabilitative aspects of critical illness.
{"title":"In a Split Second","authors":"E. Rubin","doi":"10.1093/oso/9780190077013.003.0002","DOIUrl":"https://doi.org/10.1093/oso/9780190077013.003.0002","url":null,"abstract":"This chapter details the story of a critical illness survivor and highlights aspects of the patient’s experience during an intensive care unit admission. The former patient’s story is provided to add context and perspective while highlighting the psychological and rehabilitative aspects of critical illness.","PeriodicalId":445464,"journal":{"name":"Critical Care Psychology and Rehabilitation","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128434784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-18DOI: 10.1093/oso/9780190077013.003.0016
D. Wade, Deborah Smyth, D. Howell
Research into the psychological impact of critical care has burgeoned over the past 20 years. This chapter outlines the major areas of psychological and rehabilitation research being conducted in critical care, as well as the gaps that remain to be filled. The authors review research areas corresponding to the early acute critical care phase, the in-hospital rehabilitation phase, and the post-hospital recovery period. The focus is on patient-centered research. The authors also review how clinicians can set themselves up to conduct psychological research, what kind of teams they need to assemble, and the challenges they could face working in critical care environments. The authors draw on their own experiences conducting linked, critical care psychology research studies, and compare this to methods used by other researchers.
{"title":"Research in the Critical Care Environment","authors":"D. Wade, Deborah Smyth, D. Howell","doi":"10.1093/oso/9780190077013.003.0016","DOIUrl":"https://doi.org/10.1093/oso/9780190077013.003.0016","url":null,"abstract":"Research into the psychological impact of critical care has burgeoned over the past 20 years. This chapter outlines the major areas of psychological and rehabilitation research being conducted in critical care, as well as the gaps that remain to be filled. The authors review research areas corresponding to the early acute critical care phase, the in-hospital rehabilitation phase, and the post-hospital recovery period. The focus is on patient-centered research. The authors also review how clinicians can set themselves up to conduct psychological research, what kind of teams they need to assemble, and the challenges they could face working in critical care environments. The authors draw on their own experiences conducting linked, critical care psychology research studies, and compare this to methods used by other researchers.","PeriodicalId":445464,"journal":{"name":"Critical Care Psychology and Rehabilitation","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131542549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-18DOI: 10.1093/oso/9780190077013.003.0005
O. J. Bienvenu, M. Hosey
Patients with critical illnesses face a number of severe psychic and physical stressors. Survivors often have long-term cognitive and physical impairments, as well as family, financial, and other stressors. These potential stressors increase the risk of psychiatric disturbances substantially. This chapter describes the burden of distress-related psychiatric morbidity in patients who survive critical illnesses, as well as risk factors for this morbidity. This knowledge serves as the motivation to develop new approaches that can ameliorate, or even prevent, long-term distress in survivors. The chapter also presents information about early attempts to reduce, prevent, and manage long-term psychological morbidity.
{"title":"Psychological Morbidity After Critical Illness","authors":"O. J. Bienvenu, M. Hosey","doi":"10.1093/oso/9780190077013.003.0005","DOIUrl":"https://doi.org/10.1093/oso/9780190077013.003.0005","url":null,"abstract":"Patients with critical illnesses face a number of severe psychic and physical stressors. Survivors often have long-term cognitive and physical impairments, as well as family, financial, and other stressors. These potential stressors increase the risk of psychiatric disturbances substantially. This chapter describes the burden of distress-related psychiatric morbidity in patients who survive critical illnesses, as well as risk factors for this morbidity. This knowledge serves as the motivation to develop new approaches that can ameliorate, or even prevent, long-term distress in survivors. The chapter also presents information about early attempts to reduce, prevent, and manage long-term psychological morbidity.","PeriodicalId":445464,"journal":{"name":"Critical Care Psychology and Rehabilitation","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130629170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-18DOI: 10.1093/oso/9780190077013.003.0013
C. Lassen-Greene, J. Jackson, C. Sevin
There is consensus that being critically ill contributes to the development of both new and worsening cognitive and psychological difficulties that impact functioning across multiple domains, including educational, social, and employment settings. Psychologists have become more aware of the scope and magnitude of these problems in recent years and are increasingly engaged in the provision of clinical services to this underserved medical cohort, both as individual providers and as key members of interdisciplinary teams. This chapter reviews key issues related to the needs of ICU survivors with postintensive care syndrome, discusses current outpatient treatment models, and offers a series of suggestions to help optimize the cognitive, mental, and functional health and quality of life of individuals after critical illness.
{"title":"Psychological Treatment Models for Survivors of Critical Illness","authors":"C. Lassen-Greene, J. Jackson, C. Sevin","doi":"10.1093/oso/9780190077013.003.0013","DOIUrl":"https://doi.org/10.1093/oso/9780190077013.003.0013","url":null,"abstract":"There is consensus that being critically ill contributes to the development of both new and worsening cognitive and psychological difficulties that impact functioning across multiple domains, including educational, social, and employment settings. Psychologists have become more aware of the scope and magnitude of these problems in recent years and are increasingly engaged in the provision of clinical services to this underserved medical cohort, both as individual providers and as key members of interdisciplinary teams. This chapter reviews key issues related to the needs of ICU survivors with postintensive care syndrome, discusses current outpatient treatment models, and offers a series of suggestions to help optimize the cognitive, mental, and functional health and quality of life of individuals after critical illness.","PeriodicalId":445464,"journal":{"name":"Critical Care Psychology and Rehabilitation","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130355285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-18DOI: 10.1093/oso/9780190077013.003.0010
M. C. Duggan, J. Van, E. Ely
Over half of people with critical illness are older adults, and the number of older adults admitted to intensive care units has been increasing over time. Older adults have increased vulnerability to disease, disability, and adverse outcomes across many domains. To address this most effectively, a unique, interdisciplinary approach is necessary to optimize not only survival but also functional status and quality of life. A shortage of health care professionals equipped to care for the aging population makes it imperative that all professionals become aware of basic principles of caring for older adults. To equip them to care for this complex population, this chapter provides an overview of how aging impacts multiple domains of an older person with critical illness and describes evidence-based approaches to caring for older adults with critical illness.
{"title":"Caring for Older Adults During and After Critical Illness","authors":"M. C. Duggan, J. Van, E. Ely","doi":"10.1093/oso/9780190077013.003.0010","DOIUrl":"https://doi.org/10.1093/oso/9780190077013.003.0010","url":null,"abstract":"Over half of people with critical illness are older adults, and the number of older adults admitted to intensive care units has been increasing over time. Older adults have increased vulnerability to disease, disability, and adverse outcomes across many domains. To address this most effectively, a unique, interdisciplinary approach is necessary to optimize not only survival but also functional status and quality of life. A shortage of health care professionals equipped to care for the aging population makes it imperative that all professionals become aware of basic principles of caring for older adults. To equip them to care for this complex population, this chapter provides an overview of how aging impacts multiple domains of an older person with critical illness and describes evidence-based approaches to caring for older adults with critical illness.","PeriodicalId":445464,"journal":{"name":"Critical Care Psychology and Rehabilitation","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125152688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-18DOI: 10.1093/oso/9780190077013.003.0017
D. Wade, J. Highfield
This chapter outlines the authors’ thoughts about the way critical care psychology will develop and increase its impact, for the benefit of patients, families, and staff, in the future. They review the current body of knowledge regarding the patient experience, psychological and cognitive risk factors, outcomes, and interventions in critical care and discuss how it can be strengthened and translated from testimony and theory into practice. The authors discuss the changes required in the philosophy and practice of medicine, as well as in societal trends. An international perspective is offered that briefly discusses differences between countries and how these practices might influence one another over time. The impact and unique challenges encountered during the recent COVID-19 pandemic are used to emphasize how an increased role for the critical care psychologist had already taken root more firmly in the United Kingdom than in many other countries.
{"title":"Future Directions for Psychology in Critical Care","authors":"D. Wade, J. Highfield","doi":"10.1093/oso/9780190077013.003.0017","DOIUrl":"https://doi.org/10.1093/oso/9780190077013.003.0017","url":null,"abstract":"This chapter outlines the authors’ thoughts about the way critical care psychology will develop and increase its impact, for the benefit of patients, families, and staff, in the future. They review the current body of knowledge regarding the patient experience, psychological and cognitive risk factors, outcomes, and interventions in critical care and discuss how it can be strengthened and translated from testimony and theory into practice. The authors discuss the changes required in the philosophy and practice of medicine, as well as in societal trends. An international perspective is offered that briefly discusses differences between countries and how these practices might influence one another over time. The impact and unique challenges encountered during the recent COVID-19 pandemic are used to emphasize how an increased role for the critical care psychologist had already taken root more firmly in the United Kingdom than in many other countries.","PeriodicalId":445464,"journal":{"name":"Critical Care Psychology and Rehabilitation","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133014227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-18DOI: 10.1093/oso/9780190077013.003.0015
A. Lewandowski, Brighid H. Fronapfel, J. Spector, K. Szczepkowski, Scott Davidson
This chapter discusses the ethical and professional standards affecting psychologists who provide consultation as members of interdisciplinary treatment teams in critical care and intensive care settings. The authors describe the unique characteristics of critical and intensive care units and how they contribute to complex life and death decisions, which in turn can result in unique moral, ethical, and clinical psychological dilemmas. In particular, this chapter focuses on the ethical quandaries that are commonly faced by psychologists in these highly specialized medical settings, and provides a mechanism for resolving ethical conflicts when they occur. Case examples are provided, each of which illustrate one of the ten ethical standards listed in the American Psychological Association’s code of ethics. Lastly, a model for maintaining ethical situational awareness in psychological consultations in critical care settings is proposed to serve as a guide for psychologists as they navigate and ultimately resolve challenging ethical dilemmas.
{"title":"Ethical Considerations in Psychological Consultation to Critical Care Settings","authors":"A. Lewandowski, Brighid H. Fronapfel, J. Spector, K. Szczepkowski, Scott Davidson","doi":"10.1093/oso/9780190077013.003.0015","DOIUrl":"https://doi.org/10.1093/oso/9780190077013.003.0015","url":null,"abstract":"This chapter discusses the ethical and professional standards affecting psychologists who provide consultation as members of interdisciplinary treatment teams in critical care and intensive care settings. The authors describe the unique characteristics of critical and intensive care units and how they contribute to complex life and death decisions, which in turn can result in unique moral, ethical, and clinical psychological dilemmas. In particular, this chapter focuses on the ethical quandaries that are commonly faced by psychologists in these highly specialized medical settings, and provides a mechanism for resolving ethical conflicts when they occur. Case examples are provided, each of which illustrate one of the ten ethical standards listed in the American Psychological Association’s code of ethics. Lastly, a model for maintaining ethical situational awareness in psychological consultations in critical care settings is proposed to serve as a guide for psychologists as they navigate and ultimately resolve challenging ethical dilemmas.","PeriodicalId":445464,"journal":{"name":"Critical Care Psychology and Rehabilitation","volume":"143 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133447496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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